Sagging of the cheek is related to skin elasticity, fat mass and mimetic muscle function

Identification of resibufogenin, a component of toad venom, as a novel senolytic compound in vitro and for potential skin rejuvenation in male mice

Senescent cells that accumulate with age have been shown to contribute to age-related diseases and organ dysfunction and have attracted attention as a target for anti-aging therapy. In particular, the use of senescent cell-depleting agents, or senolytics, has been shown to improve the aging phenotype in animal models. Since senescence has been implicated in the skin, particularly in fibroblasts, this study used aged human skin fibroblasts to investigate the effects of resibufogenin. A component of the traditional Chinese medicine toad venom, resibufogenin was investigated for senolytic and/or senomorphic activity. We found that the compound selectively caused senescent cell death without affecting proliferating cells, with a marked effect on the suppression of the senescence-associated secretory phenotype. We also found that resibufogenin causes senescent cell death by inducing a caspase-3-mediated apoptotic program. Administration of resibufogenin to aging mice resulted in an increase in dermal collagen density and subcutaneous fat, improving the phenotype of aging skin. In other words, resibufogenin ameliorates skin aging through selective induction of senescent cell apoptosis without affecting non-aged cells. This traditional compound may have potential therapeutic benefits in skin aging characterized by senescent cell accumulation.

Perception gap of aged facial appearance; self-perception is younger than actual status due to angle of viewing

BACKGROUND

Facial morphology changes with aging, resulting in an aged appearance that is a great matter of concern for people. However, it is not clear whether people perceive their own facial appearance accurately, in part because there are few methods to evaluate this.

AIM

The aim of this study is firstly to establish an evaluation system for the perception gap of aged facial appearance between the self-perceived status and the actual status, and then to use this evaluation system to quantify the perception gap and to clarify the mechanism of this gap METHOD: Thirty-six middle-aged female volunteers were first asked to rate their facial aging-related morphology according to a 6-grade set of photos taken at a 45° angle from the front showing progressive stages of sagging severity, without looking either in a mirror or at photos of themselves (self- or "subjective" perception). Then they were shown photos of their face taken at a 45° angle from the front, and asked again to rate their sagging grade based on these photos ("objective" rating). In addition, facial photos taken from several angles from the front to the side were evaluated for sagging severity by trained evaluators.

RESULTS

This system for analyzing perception gap revealed that the self-perception of aged appearance was significantly younger than the actual situation in three facial areas, namely the cheek, around the eyes and the facial contour, and the gap corresponded to an age difference of as much as 8 years in middle-aged females. Trained evaluators found that the severity of sagging judged from photos taken from a frontal direction was significantly less than in photos of the same subject taken from side angles. This suggests that recognition of sagging is more difficult from the front, which is the direction from which people view their own face in daily life. Indeed, viewing photos taken from the side, a rare viewing angle of one's own face, increased the motivation to improve aged appearance in more than 70% of the subjects in a questionnaire survey.

CONCLUSION

The results suggest that people perceive their own facial appearance as less aged than it actually is. The reason for this appears to be that viewing from the front, the usual viewing angle of one's own face in daily life, results in lower perceived sagging severity, likely due to reduced depth perception.

Modeling of global skin aging indices among Caucasian and Asian women

BACKGROUND

The skin aging process is defined as the gradual degradation of several skin properties such as firmness, color, or the appearance of wrinkles. These properties can be assessed by trained experts, who perform an overall evaluation of the entire face.

OBJECTIVE

The objective of this paper is the construction of two Global Skin Aging Indices specifically designed to model the overall skin aging process of Caucasian and Asian women.

METHODS

Two hundred forty Asian women and 129 Caucasian women aged between 20 and 60 years old are recruited. Parameters related to wrinkles, sagging, elasticity, and skin tone are measured (clinically or instrumentally). The global skin aging index is defined as the normalized projection on the first principal component of a principal component analysis of the skin measurements. Then, linear regressions are performed between the indices and age of both panels.

RESULTS

The first principal component carries around 50% of the initial variance for both indices. Both Global Skin Aging Indices statistically correlate with age (R2 ≥ 0.7, p-value < 0.05). An equation linking the indices with age is computed.

CONCLUSION

The proposed indices are good indicators of the overall aging process for Caucasian and Asian women. They offer new approaches to assess antiaging product efficacy.

Vellus hair condition is related to dermal elasticity and facial sagging severity

BACKGROUND

Sagging of facial skin is a critical factor associated with an aged appearance. However, the mechanism of sagging has not been fully elucidated. The facial skin contains vellus hair (fine hair), but the contribution of vellus hair to skin condition and facial aging has yet to be studied.

AIM

We aimed to clarify the influence of vellus hair on the physical properties and sagging severity of facial skin by establishing an evaluation system for vellus hair condition.

METHOD

Photographs were taken to assess the vellus hair condition in the cheek area in 30 middle-aged female volunteers. Skin elasticity was measured with a cutometer and sagging severity was evaluated by using previously established photograph-based grading criteria.

RESULTS

Facial skin vellus hairs were divided into three types: fine, thick, and normal thickness. Based on this observation, we established a 6-grade photograph-based grading system based on the dominant type of vellus hair in the target area and used it to evaluate vellus hair condition at the cheek. We found that vellus hair condition is significantly positively related to skin elasticity parameters Ua/Uf (representing overall elasticity including creep and creep recovery), Ur/Ue (representing net elasticity without viscoelastic creep), and Ur/Uf (ratio of elastic recovery to total deformation). Further, vellus hair condition was significantly negatively correlated to sagging severity.

CONCLUSION

Our results suggest that vellus hair condition positively contributes to the skin's physical properties, and consequently deterioration of the vellus hair condition promotes an aged facial appearance.

Aging Fibroblasts Adversely Affect Extracellular Matrix Formation via the Senescent Humoral Factor Ependymin-Related Protein 1

Skin senescence is characterized by a decrease in extracellular matrix and the accumulation of senescent fibroblasts in the dermis, and their secretion of humoral factors. Ependymin-related protein 1 (EPDR1) is involved in abnormal fibroblast metabolism and collagen deposition, however, its relation to skin aging is unclear. We investigated whether and how EPDR1 is involved in age-related dermal deterioration. When young dermal fibroblasts and senescent cells were co-cultured in a semipermeable membrane separation system, the young fibroblasts showed decreased gene expression of collagen type I α1 chain (COL1A1) and elastin, and increased expression of matrix metalloproteinase (MMP)1 and MMP3. Senescence marker expression and EPDR1 production were increased in the culture medium of senescent cells. Treatment of young fibroblasts with recombinant EPDR1, enhanced matrix-related gene expression and suppressed COL1A1 expression, whereas EPDR1 knockdown had the opposite effects. EPDR1 gene and protein expression were increased in aged skin, compared to young skin. These results suggest that senescent cells affect nearby fibroblasts, in part through EPDR1 secretion, and exert negative effects on matrix production in the dermis. These results may lead to the discovery of potential candidate targets in the development of skin anti-aging therapies.

Fat infiltration into dermal layer induces aged facial appearance by decreasing dermal elasticity

BACKGROUND

Facial morphology changes with aging, producing an aged appearance, but the mechanisms involved are not fully established. We recently showed that subcutaneous fat infiltrates into the dermal layer with aging, but it is not yet clear whether and how this drastic change of the dermal layer influences facial appearance.

PURPOSE

We aimed to establish the role of fat infiltration in producing an aged facial appearance and to clarify the mechanism involved.

METHODS

We analyzed the severity of fat infiltration in cheek skin of 30 middle-aged female volunteers by means of ultrasonography. Severity of the nasolabial fold, an established age-related morphology, was evaluated based on our photographic grading criteria as a measure of aged appearance. Skin elasticity was measured with a Cutometer.

RESULTS

Fat infiltration to the dermal layer was detected at the cheek skin noninvasively by means of ultrasonography. Fat infiltration severity, measured as the minimum depth of the fat inside the dermal layer from the skin surface, was positively correlated with the magnitude of the nasolabial fold. Further, fat infiltration severity was significantly negatively correlated with dermal elasticity.

CONCLUSIONS

Our results suggest that fat infiltration into the dermal layer is a critical factor inducing aged appearance of the face. The infiltrated fat decreases the dermal elasticity, which exacerbates nasolabial folds, namely producing an aged facial appearance.

Evaluation of the Efficacy and Safety of Blue Fenugreek Kale Extract on Skin Health and Aging: In-vitro and Clinical Evidences

Background

Objective

Methods

Results

Conclusion

Infiltration of subcutaneous adipose layer into the dermal layer with aging

BACKGROUND

The elasticity of the dermal layer decreases with aging, leading to ulcer formation and wrinkling, but the mechanism of this change is not fully understood, because it is difficult to access the complex three-dimensional (3D) internal structure of the dermis.

OBJECTIVE

To clarify age-dependent changes in the overall 3D structure of the dermal layer by means of 3D analysis technology.

METHODS

We observed sun-protected human skin by means of X-ray micro CT, identified the layers of the skin, and reconstructed the 3D structure on computer. Age-dependent structural changes of the dermal layer were evaluated by statistical comparison of young and aged skin.

RESULTS

Histological observations suggested the presence of two types of ectopic fat deposits, namely infiltrated subcutaneous fat and isolated fat, in the lower region of the reticular dermal layer in aged skin. To elucidate their nature, we observed skin specimens by X-ray microCT. The epidermis, dermal layer, and subcutaneous adipose layer were well differentiated on CT images, and 3D skin was digitally reconstructed on computer. This method clearly showed that the isolated fat observed histologically was in fact connected to the subcutaneous fat, namely all ectopic fat is connected to the subcutaneous adipose layer. Statistical analysis showed that the severity of fat infiltration into dermal layer is significantly increased in aged skin compared with young skin.

CONCLUSION

Our findings indicate that subcutaneous fat infiltrates into the dermal layer of aged skin. Our 3D analysis approach is advantageous to understand changes of complex internal skin structures with aging.

Evaluation by 3D stereophotogrammetry of facial changes in edentulous patients after rehabilitation

OBJECTIVE

To assess facial changes after oral rehabilitation with complete dentures (CDs) by 3D technology allows understanding the results of a treatment that changes facial proportions. Precise outcome parameters can improve decision making. This descriptive observational research aimed to assess facial changes in completely edentulous patients after oral rehabilitation with a CD by a 3D stereophotogrammetry system.

METHODOLOGY

30 edentulous patients (7 men and 23 women), aged 50 to 75, were analyzed with stereophotogrammetry at 28 previously determined anthropometric landmarks, at 2 different times: T1, before treatment, and T2, after inserting the CDs. Images were analyzed with a specific software for linear and angular measurements. The paired t-test was used to compare timestamps (α=0.05).

RESULTS

Major changes were observed in 7 of the 13 linear measures and 7 of the 9 angular measures. The following linear measurements had an increase: Sn-Gn (lower third of the face), Ls-Li (height of the vermilion lip), and ChL-ChR (mouth width). Sn-Ls (nasal philtrum height) decreased. For angular measurements, Sn-St-Pg (lower facial convexity) angles increased, and the Prn-Sn-Ls (nasolabial angle) and GoR-Pg-GoL (mandible convexity) angles decreased.

CONCLUSIONS

Major facial changes in newly rehabilitated edentulous patients with CDs included an increase of the lower third of the face, of the vermilion lip, of mouth width, and of the lower facial convexity, and a decrease of the nasolabial angle and mandible convexity.

Treating Aging Changes of Facial Anatomical Layers with Hyaluronic Acid Fillers

The aging process affects every anatomical layer of the face. Improved knowledge of how aging occurs in each anatomical layer of the face has helped evolve the facial rejuvenation strategies with HA fillers. Understanding the age-related changes in the anatomical facial layers, including their time of onset and how the changes occur in the different tissue layers, an injector can provide much more targeted and refined HA filler treatments. As fillers’ use has increased, there has been a distinct shift away from procedures lifting the skin and SMAS. We can selectively target the anatomical facial layers with HA fillers for more refined and predictable outcomes. An extensive range of HA filler variants is now available. Each filler type is optimized and designed to be injected into specific tissue planes for the best results. Knowing the predictable aging changes in the different tissue layers of the face is crucial as this guides the optimum filler choice. Working knowledge of the individual characteristics of the numerous HA-based products allows for their effective placement in the correct layer. Familiarity with the correct HA product may also help to minimize the downtime and risk of adverse events.

Midfacial Soft Tissue Changes After Reduction Malarplasty: A Computed Tomographic Study

BACKGROUND

The reduction malarplasty has become one of the most popular esthetic surgeries among Asian women to improve facial contour. However, it is still controversial whether midfacial soft tissue changes after surgery, and more studies are needed.

METHODS

This retrospective observational study reviewed 30 patients who underwent L-shaped reduction malarplasty during January 2018 and August 2019. The preoperative and postoperative soft tissue thickness and the angle of nasolabial fold of the midfacial were assessed using photographs, three-dimensional skull computerized tomography images, and the Wrinkle Severity Rating Scale.

RESULTS

The postoperative average level of nasolabial fold angle was lower than that observed in preoperative conditions, with the difference being statistically significant (t = -10.262, P < 0.001). The postoperative fifth and sixth layers of soft tissue in the midface were significantly higher than those observed in preoperative tissues.

CONCLUSIONS

Although L-shaped reduction malarplasty has evident effects on soft tissue changes of middle face, they are within acceptable ranges and do not affect patient satisfaction.

Three-Dimensional Photogrammetric Study on Age-Related Facial Characteristics in Korean Females

Background

Understanding the age-related morphological changes of facial soft tissue is fundamental in achieving improved outcomes of rejuvenating procedures. Three-dimensional (3D) photogrammetry is a reliable and convenient anthropometric tool to assess facial soft tissue.

Objective

The aim of this study was to establish age-related facial soft tissue morphology in Korean adult females using non-invasive 3D photogrammetry.

Methods

One hundred and ninety-two female participants were divided into three groups based on age: the younger group (aged 20~39 years), middle group (40~59 years), and older group (60~79 years). Thirty-six landmarks were identified via 3D photogrammetric scanning (Morpheus 3D, Morpheus Co., Ltd., Seongnam, Korea). Forty-one facial dimensions were analyzed using the imaging software to find significance between the age groups.

Results

Smaller upper-facial volume (p=0.019) and shorter upper-facial height (p=0.034) were observed in the older group than in the younger group. In the mid-face, narrowed palpebral fissure (p<0.001) with elongated upper eyelid height (p<0.001) and widened nose (p<0.001) were observed in the older group compared with the younger group. Longer lower-facial height (p<0.001) with longer and wider philtrum (p<0.001, p=0.004, respectively), shorter lower vermilion height (p<0.001), wider mouth width (p<0.001), and smaller lower vermilion angle (p<0.001) were seen in the older group when compared with the younger group. Moreover, greater angles of nasofrontal, nasomental, and labiomental angle (p=0.015, p=0.015, p=0.080, respectively), and smaller nasofacial angle (p=0.034) were observed in the older group than in the younger group.

Conclusion

Our results provide clues of aging-related facial morphological characteristics in Korean female population.

Quantitative evaluation of facial sagging in different body postures using a three-dimensional imaging technique

BACKGROUND

The possible contribution of head flexion posture while using a smartphone to the formation of "smartphone face," is an increasing concern. Smartphone face describes the facial changes in a stooped posture receiving more gravitational pull on the jowl area.

AIMS

In this study, we quantified facial sagging in different postural changes using a three-dimensional imaging technique.

METHODS

Faces of 21 young (30.45 ± 2.81 yo, n = 11) and old (59.50 ± 3.37 yo, n = 10) Korean female subjects were scanned in different body postures including standing, supine, and head flexion (30°, 45°). The landmark displacements and volumetric changes in facial areas were assessed and correlated with skin elasticity. In addition, 22 Korean female subjects (45.45 ± 3.81 yo) were recruited to test the anti-gravity effect of facial cream A, which was formulated with Stem III complex™, for 8 weeks.

RESULTS

The landmarks shifted inferior-laterally with the supine posture, while the upper face shifted more laterally and the lower face shifted more inferiorly. With a head flexion posture, facial sagging occurred mainly toward the anterior direction with more prominent changes in the lower face. The changes were greater in the older group, and skin elasticity exhibited negative correlation with the shifting distances. A significant decrease in facial sagging was noted after an 8-week treatment of facial cream A.

CONCLUSION

The use of a three-dimensional imaging technique could accurately assess the gravity-induced facial changes in different postures. The head flexion posture particularly gives more gravitational pull to the lower face, which could contribute to the drooping jawline.

Self-perceived and objective measurements of facial puffiness in Chinese women

BACKGROUND

Facial puffiness, caused by mild or normal fluid retention, commonly experienced by women, may not pose a health risk, but it can be a cause of cosmetic concern. The objectives of this study were to determine whether self-perceived facial puffiness can be measured objectively.

MATERIALS AND METHODS

A total of 151 Chinese women between 20 and 68 years of age were recruited. Facial water content, skin thickness, and elasticity were measured at two time points within a day (visit one occurred when the participants perceived they had facial puffiness; visit two occurred when the participants perceived their facial puffiness had subsided). Participants were also given a rating scale to self-evaluate their puffiness and firmness at different regions of the face.

RESULTS

The participants could perceive a difference in facial puffiness between the two visits. Water content and skin thickness were significantly higher in all regions of the face for all participants during the first visit. Skin elasticity was also significantly different between visits one and two. There was a significant increase in water content and skin thickness in the lower eyelid region in women who were older than 40 years.

CONCLUSION

This is the first study to show that self-perceived facial puffiness can be measured objectively and that skin elasticity can change significantly when facial puffiness subsides.

Myomodulation with Injectable Fillers: An Innovative Approach to Addressing Facial Muscle Movement

Consideration of facial muscle dynamics is underappreciated among clinicians who provide injectable filler treatment. Injectable fillers are customarily used to fill static wrinkles, folds, and localized areas of volume loss, whereas neuromodulators are used to address excessive muscle movement. However, a more comprehensive understanding of the role of muscle function in facial appearance, taking into account biomechanical concepts such as the balance of activity among synergistic and antagonistic muscle groups, is critical to restoring facial appearance to that of a typical youthful individual with facial esthetic treatments. Failure to fully understand the effects of loss of support (due to aging or congenital structural deficiency) on muscle stability and interaction can result in inadequate or inappropriate treatment, producing an unnatural appearance. This article outlines these concepts to provide an innovative framework for an understanding of the role of muscle movement on facial appearance and presents cases that illustrate how modulation of muscle movement with injectable fillers can address structural deficiencies, rebalance abnormal muscle activity, and restore facial appearance.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Simple procedure to evaluate mid-face sagging: A pilot study from Taiwan

An easy and objective way to evaluate mid-face sagging is marking straight lines between the nasal alar and the mandibular angle, one in the supine and the other in an upright position. The maximal distance between the two lines drawn is measured. Statistic analyses shows that this maximum distance demonstrates positive correlation with age and body mass index that reflects the level of mid-face sagging. This simple method may be utilised to evaluate the effect of anti-ageing treatment on the face in the context of mid-face sagging.

Correlation analysis between advanced glycation end products detected noninvasively and skin aging factors

OBJECTIVE

To investigate the correlation between advanced glycation end products (AGEs) and skin elasticity or blood perfusion values in healthy people of different age groups and to evaluate the relationship between noninvasive detection of AGEs and age or skin aging.

METHODS

One hundred and two healthy people were enrolled and grouped into groups of 20 years old. Group I: 19-40 years old; Group II: 41-60 years old; Group III: 61-80 years old. Noninvasive techniques such as fluorescence spectroscopy and laser speckle flowmetry were used to detect AGEs levels, local skin perfusion value, and skin elasticity in skin tissue at all age groups.

RESULT

The AGEs in the skin increased with age, and the difference between the three age groups was statistically significant (P < .05).There was no significant difference in gender between AGEs (P > .05).There was no significant relationship between AGEs and skin elasticity or blood perfusion value in the Group I; there was a low correlation between AGEs and skin elasticity in the 41-60 years age group (r < .4, P < .05). The level of AGEs in the elderly over 60 years was significantly positively correlated with skin elasticity and blooding perfusion value (r > .4, P < .05).

CONCLUSION

There is a significant correlation between AGEs and age or skin aging indicators. As the age increasing, the level of AGEs increases obviously, which can be used as a potential noninvasive tool for detecting skin aging.

Senescent dermal fibroblasts negatively influence fibroblast extracellular matrix-related gene expression partly via secretion of complement factor D

Aging is associated with a decrease of extracellular matrix and an increase of senescent cells in the dermal layer. Here, to examine whether and how senescent cells are involved in aging-related deterioration of the dermal layer, we cocultured dermal young fibroblasts (low-passage number) with senescent cells (high-passage number) in Transwells, in which the two cell types are separated by a semipermeable membrane. Young fibroblasts in coculture showed decreased collagen type I alpha 1 chain and elastin gene expression, and increased matrix metalloproteinase 1 (MMP1) gene expression. To identify causative factors, we compared gene expression of young and senescent cells and selected candidate secretory factors whose expression was increased by ≥2.5 in senescent fibroblasts. Then, we used siRNAs to knock down each of the 11 candidate genes in senescent fibroblasts in the coculture system. Knockdown of complement factor D (CFD) in senescent fibroblasts significantly reduced the increase of MMP1 in the cocultured young fibroblasts. In monocultures, treatment of young fibroblasts with CFD resulted in increased MMP1 gene expression, while knockdown of CFD in senescent fibroblasts decreased MMP1 gene expression. In addition, production of CFD was increased in culture medium of untreated senescent fibroblasts. Furthermore, CFD gene and protein expression were increased in the dermal layer of skin specimens from aged subjects (>70 years old), compared to young subjects (<20 years old). Overall, these results suggest that senescent cells negatively influence matrix production and promote degradation of nearby fibroblasts in the dermal layer, in part through secretion of CFD.

Botulinum toxin (Botox) A for reducing the appearance of facial wrinkles: a literature review of clinical use and pharmacological aspect

Background: Botulinum toxin (Botox) consists of 7 types of neurotoxins; however, only toxins A and B are used clinically. Botox A is used for several disorders in the field of medicine, particularly in dermatology, for cosmetic purposes. It is produced by the bacterium Clostridium botulinum and can be used as a treatment to reduce the appearance of wrinkles in the upper areas of the face, elevate the eyebrows and treat problems such as hyperhidrosis, lichen simplex, pompholyx (dyshidrotic eczema) and acne vulgaris.

Objectives: This article provides a literature review regarding the general issue of Botox as a treatment for reducing facial wrinkle.

Discussion: Botox works by blocking the release of acetylcholine, resulting in paralysis of the local muscles, which usually occurs 24 hrs to two weeks following Botox injection. This effect will last three to six months. The optimal dose of cosmetic Botox in dermatology is 20 units. Botox is relatively safe and does not result in any adverse side effects. However, in certain circumstances, the effect of Botox will gradually resolve, resulting in reduced muscle paralysis over time.

Conclusion: Botox is good and safe medicine to reduce the appearance of facial wrinkles.

Myomodulation with Injectable Fillers: An Innovative Approach to Addressing Facial Muscle Movement

Consideration of facial muscle dynamics is underappreciated among clinicians who provide injectable filler treatment. Injectable fillers are customarily used to fill static wrinkles, folds, and localized areas of volume loss, whereas neuromodulators are used to address excessive muscle movement. However, a more comprehensive understanding of the role of muscle function in facial appearance, taking into account biomechanical concepts such as the balance of activity among synergistic and antagonistic muscle groups, is critical to restoring facial appearance to that of a typical youthful individual with facial esthetic treatments. Failure to fully understand the effects of loss of support (due to aging or congenital structural deficiency) on muscle stability and interaction can result in inadequate or inappropriate treatment, producing an unnatural appearance. This article outlines these concepts to provide an innovative framework for an understanding of the role of muscle movement on facial appearance and presents cases that illustrate how modulation of muscle movement with injectable fillers can address structural deficiencies, rebalance abnormal muscle activity, and restore facial appearance.

LEVEL OF EVIDENCE V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Concentric Malar Lift in the Management of Lower Eyelid Rejuvenation or Retraction: A Clinical Retrospective Study on 342 Cases, 13 Years After the First Publication

BACKGROUND

Lower eyelid rejuvenation can, unfortunately, induce scleral show even if the lower eyelid procedure is limited. This study was designed to assess the effectiveness and reliability of the concentric malar lift technique in two scenarios: the first, in rejuvenation of the mid-face and, the second, in reconstructive surgery for correction of congenital or acquired eyelids malposition.

METHODS

The concentric malar lift technique was first published by Le Louarn (Aesthet Plast Surg 28(6):359-372, 2004). This retrospective study was carried out by analyzing data on patients operated on between January 2010 and January 2016. Patients operated on before 2010 were excluded because barbed thread sutures were not used in the first version of the technique. Patients after January 2016 were excluded to ensure adequate follow-up, and so 342 patients are included in the study. A total of 256 cases (75%) were for aesthetic mid-face lifting, and 86 cases (25%) were reconstructive surgeries for lower eyelid retraction. A spacer graft was used in 30 of these reconstructive cases (35%). The mean follow-up time was 13.6 months. All the concentric malar lifting procedures included strengthening the lateral canthus, which is a key element of the procedure.

RESULTS

None of the patients developed secondary eyelid malposition, and all the cases of lower eyelid retraction displayed marked improvement both functionally and aesthetically. Two patients experienced loss of sensitivity of part in the infra-orbital nerve distribution for 4 months after the procedure.

CONCLUSION

The concentric malar lift procedure enables the recruitment of a significant amount of skin into the lower eyelid: between 10 and 30 mm. It ensures better rejuvenation of the mid-face with minimal risk of lower eyelid malposition. In reconstruction of the lower eyelid lid, the concentric malar lift is able to reduce the need for skin grafting and a skin flap reducing the risks of visible scarring.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Effect of a Facial Muscle Exercise Device on Facial Rejuvenation

BACKGROUND

The efficacy of facial muscle exercises (FMEs) for facial rejuvenation is controversial. In the majority of previous studies, nonquantitative assessment tools were used to assess the benefits of FMEs.

OBJECTIVES

This study examined the effectiveness of FMEs using a Pao (MTG, Nagoya, Japan) device to quantify facial rejuvenation.

METHODS

Fifty females were asked to perform FMEs using a Pao device for 30 seconds twice a day for 8 weeks. Facial muscle thickness and cross-sectional area were measured sonographically. Facial surface distance, surface area, and volumes were determined using a laser scanning system before and after FME. Facial muscle thickness, cross-sectional area, midfacial surface distances, jawline surface distance, and lower facial surface area and volume were compared bilaterally before and after FME using a paired Student t test.

RESULTS

The cross-sectional areas of the zygomaticus major and digastric muscles increased significantly (right: P < 0.001, left: P = 0.015), while the midfacial surface distances in the middle (right: P = 0.005, left: P = 0.047) and lower (right: P = 0.028, left: P = 0.019) planes as well as the jawline surface distances (right: P = 0.004, left: P = 0.003) decreased significantly after FME using the Pao device. The lower facial surface areas (right: P = 0.005, left: P = 0.006) and volumes (right: P = 0.001, left: P = 0.002) were also significantly reduced after FME using the Pao device.

CONCLUSIONS

FME using the Pao device can increase facial muscle thickness and cross-sectional area, thus contributing to facial rejuvenation.

LEVEL OF EVIDENCE 4

Visualization of viscoelastic behavior in skin equivalent using optical coherence tomography-based straingraphy

BACKGROUND/PURPOSE

The relationships between the skin components and these mechanical roles are still unclear. To clarify these relationships, we investigated spatial mapping of the mechanical behavior of cultured skin equivalents (SEs) using optical coherence tomography (OCT)-based straingraphy.

METHODS

We built a strain relaxation test system combined with OCT and developed an algorithm that could visualize a time-dependent strain distribution, named dynamic-optical coherence straingraphy (D-OCSA). Using this system, we analyzed how the spatial mechanical changes in the SEs depended on the culture duration. For quantitative analysis of viscoelastic behavior, we defined a relaxation attenuation coefficient of strain rate, which indicates the ratio of viscosity and elasticity in the Klevin-Voight model.

RESULTS

By culturing for 4 days in comparison to culturing for 1 day, the strain relaxation attenuation coefficient of the whole skin, especially at the region of the dermal-epidermal junction (DEJ), significantly increased in the negative direction. In tissue slices taken for microscopy, several cracks were observed in the SEs cultured for 4 days.

CONCLUSION

This study is the first to provide quantified evidence that the DEJ is a dynamically specialized region. An OCT-based straingraphy system (D-OCSA) would be beneficial for evaluating the quality of SEs, as well as functional analysis of their mechanics.

Location-specific mechanical response and morphology of facial soft tissues

The facial tissue of 9 healthy volunteers (m/f; age: 23-60y) is characterized at three different locations using a procedure combining suction measurements and 18MHz ultrasound imaging. The time-dependent and multilayered nature of skin is accounted for by adopting multiple loading protocols which differ with respect to suction probe opening size and rate of tissue deformation. Over 700 suction measurements were conducted and analyzed according to location-specific mechanical and morphological characteristics. All corresponding data are reported and made available for facial tissue analysis and biomechanical modeling. Higher skin stiffness is measured at the forehead in comparison to jaw and parotid; these two regions are further characterized by lower creep deformation. Thicker tissue regions display a tendency towards a more compliant and less dissipative response. Comparison of superficial layer thickness and corresponding mechanical measurements suggests that connective tissue density determines the resistance to deformation in suction experiments.

Accessory Axillary Breast Excision with Liposuction Using Minimal Incision: A Preliminary Report

BACKGROUND

Accessory breasts have received little attention in the surgical fields, although the condition is quite common in the female population, with 2-6% of women suffering from it. Its convexity and cyclic pain make women feel embarrassed and uncomfortable, so patients often desire surgical excision to improve their appearances and to remove the pain.

METHODS

A total of 967 patients who had been treated by an excision of accessory breast tissue with liposuction using minimal incision from September 2013 to Dec 2015 at the Damsoyu Hospital were analyzed for clinical factors retrospectively.

RESULTS

All 967 patients were female. There were 514 (53.2%) unmarried patients and 453 (46.8%) married patients. The major clinical manifestation was the problem in the appearance with cyclic pain in both unmarried and married groups (82.7 vs. 87.9%). Three types of accessory breasts were observed: 779 (80.6%) breast tissue only in axillae, 182 (18.8%) breast tissue with accessory nipple, and 6 (0.6%) breast tissue with accessory nipple-areolar complex. The mean operation time was 58 min. All cyclic axillar pain in our cases was resolved after the operation. Postoperative complications developed in 160 patients (16.55%). Among them, seroma after operation was the most common (11.27%). In our study, 95.65% of the patients were satisfied with the cosmetic outcomes.

CONCLUSIONS

The surgical excision of accessory breasts with liposuction through the minimal incision is a safe and effective method to make women feel comfortable in clinical manifestations and be satisfied with their cosmetic axillar line.

LEVEL OF EVIDENCE V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Nonablative fractional laser treatment for the skin in the eye area - clinical and cutometric analysis

OBJECTIVE

The purpose of the research was to evaluate skin elasticity and reduction in the aging eye area using a 1410-nm nonablative fractional laser treatment, cutometric measurements and photographic documentation.

MATERIAL AND METHODS

This study included 24 patients (21 women, three men), aged 33-50 years (the average age was 44.6) with Fitzpatrick skin type II and III. They received five successive treatment sessions with a 1410-nm nonablative fractional laser in 2-week intervals. Biomechanical properties of the skin were measured by using Cutometer (Courage+Khazaka electronic). Measurements of skin elasticity were made in three places of the eye area. A photographic documentation was used to compare changes after the series of treatment sessions. Additionally, the patients filled in a survey in which they were asked to make a self-evaluation of the administered procedure.

RESULTS

Cutometric analysis showed a significant improvement of skin elasticity. Changes in the measurements of R2 and R6 parameters indicate that the statistical significance level is mostly P < 0.0001 for the differences in the measurements. The analysis of clinical results of the therapy, using photographic documentation, showed a 47% decrease in the quantity and depth of wrinkles in the eye area.

CONCLUSIONS

A 1410-nm nonablative fractional laser treatment seems to be an effective method aiming at reducing wrinkles in the eye area and improving tightness. Cutometric measurements provide invaluable help in the objective evaluation of the anti-aging treatment and the photographic documentation is an excellent addition to the clinical analysis.

Increment of subcutaneous adipose tissue is associated with decrease of elastic fibres in the dermal layer

Obesity is a significant risk factor for various skin disorders, including pressure ulcer and delayed wound healing. We previously showed that increment of subcutaneous adipose tissue contributes to poor skin condition by decreasing dermal elasticity. Here, we examined the mechanism involved. Histologic observation of abdominal skin from middle-aged females with a wide range of body mass index (BMI), an indicator of subcutaneous fat mass, showed that dermal elastic fibre abundance was significantly decreased with increment of BMI. Concomitantly, adipocytes were significantly enlarged. Adipocyte enlargement was significantly negatively correlated with dermal elastic fibre abundance. We hypothesized that enlarged adipocytes negatively influence dermal elastic fibres, so we investigated elastic fibre-degrading factors in in vitro-cultured enlarged adipocytes. MMP9 gene expression and secretion were significantly increased; further, these changes were blocked by extracellular signal-regulated kinase (ERK) inhibitor. Nuclear translocation (activation) of AP-1, a downstream ERK signalling molecule, was also observed in enlarged adipocytes. MMP9 abundance was significantly increased in skin of subjects with high BMI and enlarged adipocytes. These results suggest that increment of subcutaneous adipose tissue leads to adipocyte enlargement together with increased degradation of dermal elastic fibres, mediated at least in part by an ERK signalling-mediated increase of MMP9 in enlarged adipocytes.

In vivo second-harmonic generation and ex vivo coherent anti-stokes raman scattering microscopy to study the effect of obesity to fibroblast cell function using an Yb-fiber laser-based CARS extension unit

Nonlinear microscopy techniques are being increasingly used to perform in vivo studies in dermatology. These methods enable us to investigate the morphology and monitor the physiological process in the skin by the use of femtosecond lasers operating in the red, near-infrared spectral range (680-1,300 nm). In this work we used two different techniques that require no labeling: second harmonic generation (SHG) for collagen detection and coherent anti-Stokes Raman scattering (CARS) to assess lipid distribution in genetically obese murine skin. Obesity is one of the most serious public health problems due to its high and increasing prevalence and the associated risk of type 2 diabetes and cardiovascular diseases. Other than these diseases, nearly half of patients with diabetes mellitus suffer from dermatological complications such as delayed wound healing, foot ulcers and several other skin changes. In our experiment we investigated and followed the effects of obesity on dermal collagen alterations and adipocyte enlargement using a technique not reported in the literature so far. Our results indicate that the in vivo SHG and ex vivo CARS imaging technique might be an important tool for diagnosis of diabetes-related skin disorders in the near future.

Dermal anchoring structures: convex matrix structures at the bottom of the dermal layer that contribute to the maintenance of facial skin morphology

BACKGROUND/PURPOSE

Facial skin must be linked to underlying structures to maintain facial morphology and prevent sagging, but the mechanism of facial skin retention is largely unknown. We aimed to elucidate this mechanism.

METHODS

Twenty-two cheek skin specimens (age range: 10s-60s, both genders) were observed histologically. And 30 cheek of healthy Japanese volunteers (age range: 30s-50s, female) was photographed and the severity of sagging was graded. Dermal layer morphology was observed non-invasively with ultrasound. Skin-retaining force was measured with a Cutometer MPA 580(®) , and sagging severity was evaluated by grading criteria.

RESULTS

Histological observation revealed characteristic convex structures at the bottom of the dermal layer. Non-invasive study showed that the depth of the convex structures, measured by ultrasonography, was significantly negatively related to the ratio of viscoelastic to elastic distention (Uv/Ue) and positively related to the ratio of elastic recovery to total deformation (Ur/Uf) at the cheek of female volunteers, measured by cutometer. It was also negatively related to sagging severity. Further, Ur/Uf was negatively and Uv/Ue was positively related to sagging severity.

CONCLUSION

Characteristic convex structures at the bottom of the dermal layer serve as anchoring structures to maintain skin morphology.

MR relaxometry for the facial ageing assessment: the preliminary study of the age dependency in the MR relaxometry parameters within the facial soft tissue

OBJECTIVES

To investigate the location-specific tissue properties and age-related changes of the facial fat and facial muscles using quantitative MRI (qMRI) analysis of longitudinal magnetization (T1) and transverse magnetization (T2) values.

METHODS

38 subjects (20 males and 18 females, 0.5-87 years old) were imaged with a mixed turbo-spin echo sequence at 1.5 T. T1 and T2 measurements were obtained within regions of interest in six facial fat regions including the buccal fat and subcutaneous cheek fat, four eyelid fat regions (lateral upper, medial upper, lateral lower and medial lower) and five facial muscles including the orbicularis oculi, orbicularis oris, buccinator, zygomaticus major and masseter muscles bilaterally.

RESULTS

Within the zygomaticus major muscle, age-associated T1 decreases in females and T1 increases in males were observed in later life with an increase in T2 values with age. The orbicularis oculi muscles showed lower T1 and higher T2 values compared to the masseter, orbicularis oris and buccinator muscles, which demonstrated small age-related changes. The dramatic age-related changes were also observed in the eyelid fat regions, particularly within the lower eyelid fat; negative correlations with age in T1 values (p<0.0001 for age) and prominent positive correlation in T2 values in male subjects (p<0.0001 for male×age). Age-related changes were not observed in T2 values within the subcutaneous cheek fat.

CONCLUSIONS

This study demonstrates proof of concept using T1 and T2 values to assess age-related changes of the facial soft tissues, demonstrating tissue-specific qMRI measurements and non-uniform ageing patterns within different regions of facial soft tissues.

Evaluation of skin ageing: a systematic review of clinical scales

Clinical scales are widely used in anti-ageing research and practice. More than 100 skin ageing scales exist, which makes it difficult to choose outcome measures and to compare study results. The objectives were to assess and evaluate the quality of measurement properties of available clinical skin ageing scales. A systematic review was conducted. Electronic databases including Medline (1970 to June 2013) and EMBASE (1974 to June 2013) were searched via Ovid SP. To enhance the sensitivity forward searches were conducted in Scopus and Web of Science. We identified 111 scales in 52 included publications. Thirty studies had good methodology for at least one measurement property. Forty-two scales were evaluated for their test-retest or interrater reliability. Nineteen showed high reliability coefficients. A further 15 instruments were partly supported by content and/or structural and/or criterion validity and/or hypotheses-testing evidence. The majority of existing clinical skin ageing scales were developed for evaluating facial characteristics. Many scales quantify similar constructs. In contrast to the high number of available scales there is limited evidence supporting their measurement properties. Recommendations for the use of specific skin ageing scales for clinical studies must be made with caution because of the high number of studies with poor methodology. Development of new instruments should be justified, and existing ones investigated for scale behaviour using appropriate methods. Future research should aim to select and/or adapt existing scales to identify the 'best' to improve clinical research and practice.

Mécano-Stimulation™ of the skin improves sagging score and induces beneficial functional modification of the fibroblasts: clinical, biological, and histological evaluations

BACKGROUND

Loss of mechanical tension appears to be the major factor underlying decreased collagen synthesis in aged skin. Numerous in vitro studies have shown the impact of mechanical forces on fibroblasts through mechanotransduction, which consists of the conversion of mechanical signals to biochemical responses. Such responses are characterized by the modulation of gene expression coding not only for extracellular matrix components (collagens, elastin, etc.) but also for degradation enzymes (matrix metalloproteinases [MMPs]) and their inhibitors (tissue inhibitors of metalloproteinases [TIMPs]). A new device providing a mechanical stimulation of the cutaneous and subcutaneous tissue has been used in a simple, blinded, controlled, and randomized study.

MATERIALS AND METHODS

Thirty subjects (aged between 35 years and 50 years), with clinical signs of skin sagging, were randomly assigned to have a treatment on hemiface. After a total of 24 sessions with Mécano-Stimulation™, biopsies were performed on the treated side and control area for in vitro analysis (dosage of hyaluronic acid, elastin, type I collagen, MMP9; equivalent dermis retraction; GlaSbox(®); n=10) and electron microscopy (n=10). Furthermore, before and after the treatment, clinical evaluations and self-assessment questionnaire were done.

RESULTS

In vitro analysis showed increases in hyaluronic acid, elastin, type I collagen, and MMP9 content along with an improvement of the migratory capacity of the fibroblasts on the treated side. Electron microscopy evaluations showed a clear dermal remodeling in relation with the activation of fibroblast activity. A significant improvement of different clinical signs associated with skin aging and the satisfaction of the subjects were observed, correlated with an improvement of the sagging cheek.

CONCLUSION

Mécano-Stimulation is a noninvasive and safe technique delivered by flaps microbeats at various frequencies, which can significantly improve the skin trophicity. Results observed with objective measurements, ie, in vitro assessments and electron microscopy, confirm the firming and restructuring effect clinically observed.

A quantitative evaluation method using processed optical images and analysis of age-dependent changes on nasolabial lines

BACKGROUND/PURPOSE

Nasolabial lines (NL) and wrinkles of the face are major features of aging. Wrinkles have been studied widely by morphological methods using 3-dimensional (3D) photographic analysis instrument, but NL were evaluated by visual scoring usually. To evaluate NL quantitatively, another method is needed. This study is purposed to find out quantitative method for evaluation of NL.

METHOD

One hundred Korean female subjects aged 20 to 60 were recruited in this study. Facial image was taken using light source adjusted VISIA-CR(®) and 3-dimensional wrinkle depth on the NL area was evaluated by Phase shift rapid in vivo measuring of human skin (PRIMOS(®)). The pixel number of NL area and the angle were obtained using processed images. The severity of NL was assessed by visual score. Skin elasticity was measured by Cutometer(®) MPA580. Statistical significance was determined at P < 0.05.

RESULT

The optical images obtained by light source adjusted VISIA-CR(®) were easy to distinguish NL and significantly increased age-dependently. And three parameters of elasticity (R2, R5, and R7) on NL area were gradually decreased with age. The Pearson correlation coefficient was -0.756 (P < 0.01) between R7 parameter and ages. Also the pixel number of NL area, angle, wrinkle depth on the NL area (Ra), and visual score were decreased elasticity-dependently. The pixel number of NL area was highly related to Ra (r = 0.567, P < 0.01) and visual score (r = 0.647, P < 0.01).

CONCLUSION

This study has shown that NL severity is related to decrease of dermal elasticity and age using quantitative new method by processing optical images.

Evaluation of nasal reconstruction procedures results

Before undergoing a reconstructive procedures of the nose most patients ask how they will look postoperatively. Anthropometric measurements of the nose described by Farkas represent standard values. A comparison of pre- and postoperative anthropometric measurements may help to double-check the correctness of intraoperative "eye-balling" measurements with regards to postoperative appearance. Sixty-three patients underwent reconstruction of nasal ala, tip or dorsum. An analysis of standardized pre- and postoperative photographs included measurements of nose width, nose height, nasal tip protrusion, columella width, ala length, intercanthal width, mouth width, philtrum width, upper lip height, lateral upper lip height, cutaneous upper lip height and upper face height. Preoperative measurements were compared to data given by Farkas in young adults. Postoperative changes were evaluated clearly distinguishing between reconstruction of nasal ala, tip and dorsum. All anthropometric indices showed significant differences compared to the Farkas population. There was no significant pre- to postoperative change in any reconstructed region observed, indicating adequate intraoperative measurements. The application of Farkas' anthropometric measurements described in this study showed reliable and objective results and can help to double-check the previous intraoperative measurements. The correct application of these surgical techniques leads to a satisfying and near to normal postoperative look of the patient.

Lip reconstruction: an anthropometric and functional analysis of surgical outcomes

Postoperative evaluation of results of reconstructive procedures of the lips mainly consists of describing the technique, complications and subjectively interpreted patient photographs. The authors present a photo-assisted pre- to postoperative evaluation of reconstructive procedures of the lips based on anthropometric measurements and functional outcome. Forty-eight patients underwent partial or full thickness excision of tumours of the lips and subsequent reconstruction. An analysis of standardized pre- and postoperative photographs included measurements of intercanthal width, mouth width, philtrum width, lateral upper lip height, upper and lower lip height, cutaneous upper and lower lip height, upper and lower vermilion arc and upper and lower vermilion height. Assessment of functional outcome consisted of the evaluation of oral competence, changes of oral opening and sensation. The effects on the described parameters were analysed, when partial or full thickness reconstruction had to be performed. Intercanthal mouth width index, vermilion arc index, vermilion and cutaneous total lower lip height index showed statistically significant effects postoperatively which indicates a postoperative tightened lower lip, when full-thickness excision was performed. In all patients the indices were proven reproducible and reliable. The standardized measurements described are accurate and objective for evaluating postoperative results.

A three-dimensional construct of the aging eyebrow: the illusion of volume loss

BACKGROUND

The eyebrows and eyebrow fat pads, key structures in upper facial aesthetics, are particularly vulnerable to age-related changes.

OBJECTIVES

In this study, the authors compare the impact of aging on the eyebrows and eyebrow fat pad volume in men and women through three-dimensional (3D) volumetric analysis.

METHODS

Electronic medical records of patients seen at the Jules Stein Eye Institute in the Division of Orbital and Ophthalmic Plastic Surgery between 2005 and 2010 were reviewed. Patients were included if they had undergone investigative imaging of the orbit for unilateral pathology. Computed tomography (CT) scans of patients with Graves disease diagnosis, extensive orbital trauma, and/or previous eyebrow surgery were excluded. A total of 52 CT scans (24 men and 28 women) were retained for analysis. A 3D reconstruction software was used to analyze the scans and calculate volumes of the retroorbicularis oculi fat (ROOF), galeal fat (ROOF and subcutaneous fat), and soft tissue muscles.

RESULTS

Galeal and brow fat volumes showed a significant positive trend toward enlargement in women (P values of .01 and .05, respectively). Although men showed a tendency toward fat enlargement with age, this was not statistically significant. Soft tissue-muscle volume decreased significantly in aging women (9.32 mm(3)/y) (P = .02). Data indicated that soft tissue volume in men tended to increase with age (3.92 mm(3)/y) but not significantly (P = .36). Neither total volume nor brow thickness appeared to change significantly in women (P = .56, P = .73). In men, total volume and brow thickness showed weak evidence of increasing with age (P = .12, P = .22). Linear regressions of Hertel measurements with and without sex interaction showed no statistically significant trend between the amount of proptosis and the galeal or brow fat.

CONCLUSIONS

Although overall eyebrow volume does not change with age, the relative contribution of fat and soft tissue to the total volume does seem to change. This pattern also differs between males and females. As women age, the fat volume increases and the soft tissue volume decreases. In men, the shift from soft tissue volume to fat volume is less pronounced. Although many clinicians have been drawn to the concept of fat volume deflation as a key element of facial aging, this study does not support this perspective in the eyebrow fat pad. An increasingly refined understanding of the dynamics of facial aging is mandatory for clinical diagnosis and will likely provide the framework from which to develop more innovative treatment options.

Negative regulation of dermal fibroblasts by enlarged adipocytes through release of free fatty acids

Subcutaneous adipose tissue lies just beneath the dermal layer, but the interaction between the two types of tissue remains obscure. Recently, we reported that obesity is associated with decreased dermal elasticity. To investigate the mechanism of the adipose tissue/dermal interaction, fibroblasts were cocultured with small or enlarged adipocytes, using a membrane insert to prevent direct contact. Enlarged adipocytes reduced 3T3-L1 fibroblast proliferation and gene expression of collagen (I)-α1 (col (I)-α1) and elastin while increasing gene expression of matrix metalloproteinase 13 (MMP13). In contrast, small adipocytes had no such effects. These results indicate that factors secreted by enlarged adipocytes influence dermal condition. As enlarged adipocytes are known to release free fatty acids (FFAs), the effects of these acids on 3T3-L1 fibroblasts were examined. Palmitic acid decreased fibroblast proliferation, reduced gene expressions of col (I)-α1 and elastin, and increased MMP13. Similar effects were observed in human dermal fibroblasts. The influence of palmitic acid on fibroblasts was inhibited by eicosapentaenoic acid (EPA), an inhibitor of Toll-like receptors (TLRs). Furthermore, EPA inhibited the effects of enlarged adipocytes on fibroblasts in the coculture system. These data indicate that enlarged adipocytes negatively control the function of dermal fibroblasts through the activation of TLRs by secreted FFAs.

Increased subcutaneous adipose tissue impairs dermal function in diet-induced obese mice

Increment of subcutaneous adipose tissue is a risk factor for facial morphological changes, such as sagging, which may be at least partly because of the increased weight burden of accumulated fat. However, it is not clear how the increase of subcutaneous adipose tissue affects dermal structure and function. We examined this issue in HR-1 hairless mice given a high-fat diet (HFD). After having been fed with HFD for 12 weeks, the mice became obese and the subcutaneous adipose tissue layer was significantly thickened, while the dermal layer became significantly thinner than that of control mice fed normal diet. However, the thickness of the dermal layer was not changed in the ear pinna, which lacks a subcutaneous adipose layer, suggesting that increase of subcutaneous adipose tissue may induce dermal changes. The number of dermal fibroblasts in the dermis was significantly reduced in obese mice, although there was no change in gene expression levels of extracellular matrix components, including collagen, hyaluronic acid synthase, fibulin5, fibrillin-1, laminin β1, matrix metalloproteinases and tissue inhibitor of metalloproteinases. Dermal elasticity was significantly decreased in obese hairless mice. These results suggest that subcutaneous adipose cells in obese mice may reduce the proliferation of dermal fibroblasts and induce a decrease of dermal thickness and elasticity. Therefore, the increment of the subcutaneous adipose layer in obese subjects may induce impairment of dermal biomechanical characteristics and promote the appearance of sagging.